Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer

Steven M. Keller, Sudeshna Adak, Henry Wagner, David H. Johnson, Robert L. Comis

Research output: Contribution to journalArticle

281 Citations (Scopus)

Abstract

Background. Mediastinal lymph node dissection (MLND) is an integral part of surgery for non-small cell lung cancer (NSCLC). To compare the impact of systematic sampling (SS) and complete MLND on the identification of mediastinal lymph node metastases and patient survival, the Eastern Cooperative Oncology Group (ECOG) stratified patients by type of MLND before participation in ECOG 3590 (a randomized prospective trial of adjuvant therapy in patients with completely resected stages II and IIIa NSCLC). Methods. Eligibility requirements for study entry included a thorough investigation of the mediastinal lymph nodes with either SS or complete MLND. The former was defined as removal of at least one lymph node at levels 4, 7, and 10 during a right thoracotomy and at levels 5 and/or 6 and 7 during a left thoracotomy, while the latter required complete removal of all lymph nodes at those levels. Results. Three hundred seventy-three eligible patients were accrued to the study. Among the 187 patients who underwent SS, N1 disease was identified in 40% and N2 disease in 60%. This was not significantly different than the 41% of N1 disease and 59% of N2 disease found among the 186 patients who underwent complete MLND. Among the 222 patients with N2 metastases, multiple levels of N2 disease were documented in 30% of patients who underwent complete MLND and in 12% of patients who had SS (p = 0.001). Median survival was 57.5 months for those patients who had undergone complete MLND and 29.2 months for those patients who had SS (p = 0.004). However, the survival advantage was limited to patients with right lung tumors (66.4 months vs 24.5 months, p < 0.001). Conclusions. In this nonrandomized comparison, SS was as efficacious as complete MLND in staging patients with NSCLC. However, complete MLND identified significantly more levels of N2 disease. Furthermore, complete MLND was associated with improved survival with right NSCLC when compared with SS. (C) 2000 by The Society of Thoracic Surgeons.

Original languageEnglish (US)
Pages (from-to)358-366
Number of pages9
JournalAnnals of Thoracic Surgery
Volume70
Issue number2
DOIs
StatePublished - 2000
Externally publishedYes

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Lymph Node Excision
Non-Small Cell Lung Carcinoma
Survival
Lymph Nodes
Thoracotomy
Neoplasm Metastasis
Patient Rights
Lung

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. / Keller, Steven M.; Adak, Sudeshna; Wagner, Henry; Johnson, David H.; Comis, Robert L.

In: Annals of Thoracic Surgery, Vol. 70, No. 2, 2000, p. 358-366.

Research output: Contribution to journalArticle

Keller, Steven M. ; Adak, Sudeshna ; Wagner, Henry ; Johnson, David H. ; Comis, Robert L. / Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. In: Annals of Thoracic Surgery. 2000 ; Vol. 70, No. 2. pp. 358-366.
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abstract = "Background. Mediastinal lymph node dissection (MLND) is an integral part of surgery for non-small cell lung cancer (NSCLC). To compare the impact of systematic sampling (SS) and complete MLND on the identification of mediastinal lymph node metastases and patient survival, the Eastern Cooperative Oncology Group (ECOG) stratified patients by type of MLND before participation in ECOG 3590 (a randomized prospective trial of adjuvant therapy in patients with completely resected stages II and IIIa NSCLC). Methods. Eligibility requirements for study entry included a thorough investigation of the mediastinal lymph nodes with either SS or complete MLND. The former was defined as removal of at least one lymph node at levels 4, 7, and 10 during a right thoracotomy and at levels 5 and/or 6 and 7 during a left thoracotomy, while the latter required complete removal of all lymph nodes at those levels. Results. Three hundred seventy-three eligible patients were accrued to the study. Among the 187 patients who underwent SS, N1 disease was identified in 40{\%} and N2 disease in 60{\%}. This was not significantly different than the 41{\%} of N1 disease and 59{\%} of N2 disease found among the 186 patients who underwent complete MLND. Among the 222 patients with N2 metastases, multiple levels of N2 disease were documented in 30{\%} of patients who underwent complete MLND and in 12{\%} of patients who had SS (p = 0.001). Median survival was 57.5 months for those patients who had undergone complete MLND and 29.2 months for those patients who had SS (p = 0.004). However, the survival advantage was limited to patients with right lung tumors (66.4 months vs 24.5 months, p < 0.001). Conclusions. In this nonrandomized comparison, SS was as efficacious as complete MLND in staging patients with NSCLC. However, complete MLND identified significantly more levels of N2 disease. Furthermore, complete MLND was associated with improved survival with right NSCLC when compared with SS. (C) 2000 by The Society of Thoracic Surgeons.",
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